超声引导下PTA治疗动静脉内瘘狭窄失败病例分析  

Failure case analysis of ultrasound-guided PTA in the treatment of arteriovenous fistula stenosis

作　　者：刘可[1] 袁媛[1] 刘承玄[2] 任德伟 LIU Ke;YUAN Yuan;LIU Chengxuan;REN Dewei(Department of Ultrasound,Chongqing Traditional Chinese Medicine Hospital,Chongqing 400021,China;Department of Nephrology,Chongqing Traditional Chinese Medicine Hospital,Chongqing 400021,China)

机构地区：[1]重庆市中医院超声科,400021 [2]重庆市中医院肾病科,400021

出　　处：《重庆医学》2021年第3期436-439,共4页Chongqing medicine

基　　金：重庆市卫生健康委员会中医药科技项目(2019ZY3130);重庆市科研机构绩效激励引导专项(cstc2018jxjl130023)。

摘　　要：目的分析超声引导下经皮腔内血管成形术(PTA)治疗动静脉内瘘狭窄失败的原因。方法选取2019年1月至2020年3月因动静脉内瘘狭窄于该院行PTA的35例患者为研究对象,回顾性分析其临床资料。结果超声引导下PTA前后血管狭窄处内径分别为(1.102±0.424)、(2.943±0.760)mm,肱动脉流量分别为(224.0±131.9)、(623.4±176.9)mL/min,差异有统计学意义(P<0.05);成功病例31例,技术成功率及临床成功率均为88.5%;失败病例4例,失败率为11.4%,其中1例为狭窄处管壁簇状钙化,残余管腔连续多发过度狭窄;1例为引流静脉扭曲成角,导丝无法通过;1例为手术时间较长,桡动脉血栓形成;1例为引流静脉瘤样扩张段内血栓残留。结论术前对透析通路做详细的超声评估来制订合理的手术方案,术中注意正确的操作手法,以此来提高PTA的成功率。Objective To analyze the reasons of failure of ultrasound-guided percutaneous transluminal angioplasty(PTA)in the treatment of arteriovenous fistula stenosis.Methods A total of 35 patients with arteriovenous fistula stenosis who underwent PTA in hospital were collected from January 2019 to March 2020,and their clinical data were analyzed retrospectively.Results Before and after interventional ultrasound PTA,the internal diameter of stenosis was(1.102±0.424)and(2.943±0.760)mm,respectively,the flow of brachial artery was(224.0±131.9)and(623.4±176.9)mL/min,respectively,the difference was statistically significant(P<0.05).There were 31 cases of success,with the technical success rate of 88.5%and clinical success rate of 88.5%.There were 4 cases of failure,with the failure rate of 11.4%.Conclusion Perform a detailed ultrasound evaluation of the dialysis pathway before the operation,and pay attention to the correct operation technique during the operation to improve the success rate of PTA.

关 键 词：超声检查 多普勒 彩色 动静脉瘘 血管成形术 治疗失败 病例报告 

分 类 号：R445.1[医药卫生—影像医学与核医学]